Men found to be anorexic, bulimic also
Contrary to the long-held belief that anorexia and bulimia are female afflictions, the first national survey on eating disorders has found that one-quarter of adults with the conditions are men.
The study estimated that about 850,000 men had suffered from the disorders and, despite two decades of intense attention to the conditions, had gone largely undetected.
“This is a very important finding,” said Ruth Streigel-Moore, an eating disorders expert at Wesleyan University who was not connected with the study. “It suggests a need to move away from gender-based explanations.”
The researchers said the findings, which appear today in the journal Biological Psychiatry, indicated men are vulnerable to the same social pressures that lead some women to uncontrollably binge and purge on food and others to starve themselves.
“Body image has become more important among men,” said co-author Dr. Harrison G. Pope Jr., a professor of psychiatry at Harvard Medical School. “There’s a large, silent population of men who might be quite ill.”
Overall, the survey found that 4.5% of adults, or 9.3 million people, have struggled with an eating disorder sometime in their lives. Anorexia accounted for 1.3 million of the cases, and bulimia 2.1 million. Binge eating, a disorder of frequent, uncontrollable periods of gorging, accounted for the largest number of cases, 5.9 million.
The study, conducted by researchers at Harvard University Medical School, was based on information obtained from the National Comorbidity Survey Replication, a mental health survey of nearly 9,000 adults across the U.S.
Funding for the study came from several sources, including the National Institutes of Health and pharmaceutical companies Eli Lilly & Co. and Johnson & Johnson, both of which sell drugs that are used as off-label treatments for eating disorders.
The survey found the prevalence of eating disorders has been rising since World War II. The lifetime risk of 18-year-olds developing an eating disorder is twice that of their parents, according to the report.
Role of fast food
Researchers haven’t pinpointed the cause of eating disorders but said heredity and the environment, including a societal obsession with thinness and the proliferation of calorie-laden fast food, are factors.
People with anorexia are obsessed with their body weight and diet to the point that they become dangerously thin.
Half of the people with the disorder binge on food and then purge by vomiting or using laxatives or diuretics.
The other half restricts the food they eat and excessively exercises. The disorder is fatal in 10% of cases.
People with bulimia eat a lot of food in a short amount of time and then try to prevent weight gain by vomiting or taking laxatives to get rid of the food.
Bulimics also may exercise or use diuretics to keep off extra pounds, but they generally maintain a normal body weight. It also can be fatal.
Dr. Walter H. Kaye, director of the eating disorders program at UC San Diego, who was not involved in the research, said that men with eating disorders may have escaped attention because they are less likely to seek psychological help in general and because the extent of their illnesses may not be as severe.
“It could be that eating disorders are associated with women, so men may not even recognize eating disorders in themselves,” he said.
Buffeted by fitness craze
Pope said the findings showed that men too had been buffeted by the fitness craze of recent years.
“The cynical interpretation would be that all the industries that have preyed upon women have saturated the female market and are turning their attention to the other 50% of the population,” he said.
One of the key findings of the survey was the length of time that the disorders persisted.
It found that bulimia and binge eating persisted for an average of eight years, while anorexia was far more transient, typically lasting for one year.
Kaye, who is researching the genetic basis of eating disorders, said the finding about anorexia was puzzling. The medical community has long regarded anorexia as a chronic condition, he said.
“I have been doing this for 25 years, and I know a number of people who have died and have been chronically ill for many years,” he said.
Jeanine Cogan, policy director of the Washington-based Eating Disorders Coalition, worried the finding might cause some to dismiss the severity of the disorder. “Anorexia is not just a passing phase,” she said.
Binge eating is not considered a life-threatening condition. Nearly 15% of people with binge-eating disorder are severely obese, which can lead to heart disease, diabetes and other serious health problems.
More than half of binge eaters are women.
As with anorexia and bulimia, binge eating is associated with mood disorders.
Pope said that binge eating is not the same as eating too much. “These are people who sit down to have a couple potato chips and all of a sudden they can’t stop eating, and they want something sweet, and they want something salty, and the next thing they know they are completely stuffing themselves,” he said. “It is quite different from the munching you would do watching the Super Bowl.”
Binge-eating disorder isn’t classified as an official medical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the bible of the psychiatric profession.
Dr. James I. Hudson, lead author of the report, said the latest findings argued that it should be included, which would allow patients to receive insurance reimbursement for treatment.
*
